By Kaleem Hawa, University of Toronto

Intro

In the past decade, health issues have become more prominent in the foreign policies of the world’s nations. Broad strategies have been formulated to address health challenges and global health has begun to enjoy greater acknowledgment in the interplay of global political relationships.1 Normally, when foreign policy-makers have focused on public health, it has been in times of major crisis, as was the case with SARS and avian flu; in the absence of such crises, health has often fared poorly when weighed against more pressing and politically-driven priorities such as international trade or security. No doubt, the onset of greater interdependence brought on by globalization has resulted in a collective vulnerability that requires nations to care more strongly about the systems of health in the developing world and thus, to tailor their foreign policies to better advocate on behalf of proven health systems.2 This research article will uncouple the roots of the global health-foreign policy framework, explore examples of how global health has become a tool of national foreign policies, and summarize World Health Organization (WHO) developments in merging the two areas on the global stage.

The Link Between Health and Foreign Policy

Two major global agendas have become inextricably linked to global health issues. As a result, foreign policy has needed to adapt to better accommodate health in its prioritization of global socio-economic policy.3 The first major area is security. Fear of global pandemics enhanced by humanitarian conflict and transportation interconnectedness has made the concept of biosecurity a very prominent one. Biosecurity originally found its roots in the exploration of preventative measures to combat the growing use of biological weaponry in modern warfare. Recently though, pandemics originating in nations with poor healthcare systems present a significant danger to the rest of the world and thus have become a prominent feature in foreign policy decision calculus.4 This is a new threat to security – one that requires neither malicious intent nor technological capacity. Its proliferation is catalyzed merely by the natural agents of modernism around the globe. The immateriality of global health security threats does not mean, however, that it exists outside the corrective realm of diplomatic policy; in fact, nations are increasingly seeing the need to strongly integrate health considerations into national foreign policy.

The second global agenda that has had to come to grips with global health challenges is the global economy. A report by Thomas N. Chirikos in the Review of Economics and Statistics found that poor health history is one of the single largest determinants of annual hours of work for employed individuals.5 Thus, it is clear that poor systems of health in the nations will produce ancillary harms in the realm of economic advancement and opportunity. Given how reliant the world has become on globalized forces of labour, adopting health as part of foreign policy goals could be a powerful way to improve trade relationships and productivity for both the developed and developing world.

Global Health as a Tool of Foreign Policy

From our understanding of the benefits associated with coupling global health and foreign policy comes an exploration of how those links have been adopted by the nations of the world. Most of the health and foreign policy linkages come from the lens of relationship building. Brazil is perhaps the best example of a nation that has successfully integrated global health activities into its economic and political agenda. After publicly declaring global health and the combat of HIV/AIDS as a tenet of its foreign policy in 2009, Brazil established stronger programmes of AIDS funding to developing countries such as South Africa.3 In doing so, Brazil strengthened its economic trade relationships with African countries and built alliances of trust that helped it gain support for its political agendas within the United Nations.3 This meant that Brazil could now count on the support of many African nations as it pursued Security Council reform, among other initiatives. In this way, global health plays a clear role in the advancement of both Brazil’s economic and political goals.

The other side of relationship building centres around military conflict, reflecting a larger nuance within the global health and foreign policy framework. In a military conflict, foreign policy can be seen as a primary antagonist when trying to promote global health goals.6 Excluding combat deaths in an armed conflict, there are often indirect deaths stemming from war-induced violence, injury, disease, and malnutrition. Thus, it becomes especially important to transform the foreign policy goal of conflict into a harm mitigator and trust-builder. Health can serve as a good entry point by which to initiate dialogue across borders and thus contribute to building trust between parties; despite animosities between nations, establishment of temporary medical clinics and transfer of medical aid can be powerful tools in the mitigation of civilian casualties because they are unlikely to be opposed by the recipient party.6

WHO Developments

One of the most powerful vindications of global health as part of the foreign policy framework was the Foreign Policy and Global Health Initiative (FPGHI). Launched jointly by the WHO and the foreign ministers of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand, it sought to promote the use of a health lens in formulating foreign policy. A joint statement released by the Ministers of Foreign Affairs of those nations in 2007 is particularly indicative of the dogmatic change:

“In today’s era of globalization and interdependence there is an urgent need to broaden the scope of foreign policy. We believe that health is one of the most important, yet still broadly neglected, long-term foreign policy issues of our time. There is a growing awareness that investment in health is fundamental to economic growth and development. It is generally acknowledged that threats to health may compromise a country’s stability and security. We believe that health as a foreign policy issue needs a stronger strategic focus in the international agenda” – Oslo Ministerial Declaration6

Another global policy network produced from the interaction of the global health and foreign policy issue areas is the Global Health Security Initiative (GHSI). The GHSI was designed as an “international partnership to strengthen health preparedness and global response to biological, chemical, radio-nuclear and pandemic influenza threats” and was launched in November 2001 by Canada, the European Commission, France, Germany, Italy, Japan, Mexico, the United Kingdom, and the United States of America.7 Again, this initiative indicated that the WHO has been attempting to bridge the divide between the two issue areas through an active policy of global health diplomacy.

In the end, the number of nations that have adopted global health in their foreign policy agendas coupled with an increased focus on the topics within the realm of NGOs and policy institutions like the WHO symbolizes the growth this new policy area has enjoyed. More focus will be needed to adequately face the challenges on the horizon but it is now clear that a unique set of foreign policy tools – once thought to be solely within the domain of state-centric military and economic negotiations – can become even better utilized within the context of international health.